Friday, December 10, 2010

Health Reform Law Tells No Story

Why is the Affordable Care Act (ACA) so unpopular with such an uncertain future?

• It is misnamed. It is not “affordable.” It contains few cost controls.

• It is misunderstood.
Critics have successfully mislabeled it as a “government takeover of health care” and as containing “death panels.”

It has grave consequences. Sixty percent of doctors say reform will force them to close or restrict their practices - 93 percent say that decision would affect Medicaid patients, and 87 percent say they'd exclude some or all Medicare patients

• It tells no story.
The public does not understand it.

On the last bullet point, Jonathan Oberlander, PhD health analyst at the University of North Carolina has this to say(“Beyond Repeal – The Future of Health Reform," New England Journal of Medicine, December 9, 2010).

"The law suffers from something of an identity crisis. After all, unlike Medicare or Social Security, the ACA is not a single program. Rather, it is a collection of mandates, public insurance expansions, subsidies, and regulations that affect different groups of Americans in different ways and at different times. During the reform debate, Democrats were never able to stitch those disparate elements together and give insured Americans — including Medicare beneficiaries, a politically crucial constituency — a simple, coherent story about how the ACA would benefit them."

Given the lack of a story line, what is future of health reform?

Its future hinges on politics- the politics of the Obama Administration versus the Supreme Court, the politics of the federal government versus state governments, and the politics leading up the 2012 presidential election and thereafter.

How the then president interacts with both houses of Congress, both likely to have Republican majorities, will determine the future of health reform.

Tweet. The health reform law’s future is cloudy. Republicans will try to repeal or slow it, and after 2012, they may be able to. @rreecemd.

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